Regional Variation in Billed Advance Care Planning Visits.
Regional Variation in Billed Advance Care Planning Visits.
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DOI：
10.1111/jgs.16730
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发表时间：
2020-11
影响因子：
6.3
通讯作者：
Burke JF
中科院分区：
文献类型：
--
作者：
Skolarus LE;Lin CC;Kerber KA;Burke JF
先进的护理计划（ACP）与改善患者和护理人员的结果，但未得到充分利用。为了鼓励ACP，医疗保险和医疗补助服务中心（CMS）在2016年实施了特定的ACP访问报销代码。为了更好地了解这些ACP报销代码的使用情况，我们探讨了ACP付费访视的区域差异。我们使用2017年随机抽样的5%医疗保险按服务收费（FFS）受益人索赔文件进行了回顾性横断面分析。区域由医院转诊区域（HRR）定义。全国医疗保险按服务收费（FFS）130万65岁及以上的医疗保险受益人。接收已计费的ACP服务，通过当前程序术语代码99497或99498识别。计算了按区域分列的接受收费ACP服务的受益人比例。我们拟合了一个具有随机区域截距的多水平logistic回归模型，以确定在考虑患者（人口统计学，合并症和医疗保健利用率）和区域因素（医院规模，急诊科就诊，临终关怀利用率和成本）后，该地区可归因于计费ACP访视的变化。研究人群包括约130万受益人，其中32，137人（2.4%）在2017年至少进行了一次ACP检查。各地区接受非加太收费医疗服务的受益人比例差异很大;最低的五分之一地区<0.83%，随后的五分之一地区<1.6%，<2.4%，最高的五分之一地区<3.3%至<8.4%。15.4%的差异，在一个老年人是否有一个收费的ACP访问是由该地区解释。虽然许多区域因素与ACP付费访问相关，但没有一个是强有力的预测因素。2017年，我们发现，尽管所有地区的总体使用率都很低，但使用收费ACP访视的地区差异很大。增加司机的了解和收费ACP访问的影响可以为增加ACP的战略提供信息。
Advance care planning (ACP) is associated with improved patient and caregiver outcomes, but is underutilized. To encourage ACP the Centers for Medicare & Medicaid Services (CMS) implemented specific ACP visit reimbursement codes in 2016. To better understand the utilization of these ACP reimbursement codes, we explored regional variation in billed ACP visits. We performed a retrospective cross-sectional analysis using a randomly-sampled 5% cohort of Medicare fee-for-service (FFS) beneficiaries’ claims files from 2017. Region was defined by Hospital Referral Region (HRR). National Medicare fee-for-service (FFS) 1.3 million Medicare beneficiaries aged 65 and older. Receipt of billed ACP service, identified through Current Procedural Terminology codes 99497 or 99498. Proportion of beneficiaries who received billed ACP service(s) by region was calculated. We fit a multi-level logistic regression model with a random regional intercept to determine the variation in billed ACP visits attributable to the region after accounting for patient (demographics, comorbidities and medical care utilization) and regional factors (hospital size, Emergency Department visits, hospice utilization and costs). The study population included about 1.3 million beneficiaries of which 32,137 (2.4%) had at least one billed ACP visit in 2017. There was substantial regional variation in the percentage of beneficiaries with billed ACP visits; lowest quintile region <0.83%, subsequent regions <1.6%, <2.4%, <3.3% to <8.4% in the highest quintile regions. 15.4% of the variance in whether an older adult had a billed ACP visit was explained by the region. While numerous regional factors were associated with billed ACP visits, none were strong predictors. In 2017, we found wide regional variation in the use of billed ACP visits although use overall was low in all regions. Increasing the understanding of the drivers and the effects of billed ACP visits could inform strategies for increasing ACP.
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影响因子：
6.3
作者：
Bischoff KE;Sudore R;Miao Y;Boscardin WJ;Smith AK
通讯作者：
Smith AK
影响因子：
39.2
作者：
Sudore RL;Fried TR
通讯作者：
Fried TR
影响因子：
4.7
作者：
Sudore, Rebecca L.;Lum, Hillary D.;Heyland, Daren K.
通讯作者：
Heyland, Daren K.
影响因子：
3.3
作者：
Wright, Megan S.
通讯作者：
Wright, Megan S.
DOI：
10.1136/bmj.c1345
发表时间：
2010-03-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Detering KM;Hancock AD;Reade MC;Silvester W
通讯作者：
Silvester W